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"Oh, my aching back!" is a phrase used by four out of five of us, at least once in our lives, to describe any of a host of things that can go wrong with our backs. Here are the most common causes:

Muscles and ligaments

The most common source of pain is a strained muscle or ligament. Either can result from underconditioning (playing two hours of tennis after being inactive for several months); overexertion (doing a lot of heavy lifting); or forcing your back into a position it's not designed for (twisting to reach something in the back seat of your car, or doing a lot of bending, sitting -- or standing still). Poor posture, weak muscles, having your center of balance shifted by pregnancy, excess weight around the middle, and high-heeled shoes can also contribute to muscle and ligament strain.

Disks

In some cases, back pain occurs when a disk gets squashed and presses on a nerve. Imagine that you have a small water balloon sandwiched between your hands. Your hands are two vertebrae; the balloon, which keeps your vertebrae from banging into and rubbing against each other, is the disk. Now press down a little on one side of the balloon. That's what happens when you bend your back. Notice how the balloon expands on the other side? After years of constant pressure -- or one swift, ill-advised move -- the disk can bulge out from between your vertebrae or even rupture. That's a herniated disk. Keep in mind, however, that recent studies show that herniated disks are relatively common but, surprisingly, rarely cause pain.

Bones

Arthritis can cause back pain if the joints in your spine become inflamed. Osteoporosis (thinning of the bones) causes bones to weaken, which can lead to painful fractures or compression. Spinal stenosis, a narrowing of the spinal canal, puts pressure on the spinal cord housed inside, resulting in pain.

Psychological stress

Many experts have observed that stress can aggravate back pain and slow recovery. In a small number of cases, it may actually be the primary cause of the pain. One controversial theory of how this might work, called tension myositis syndrome, was developed by Dr. John Sarno. Sarno, the author of Healing Back Pain, believes that most back pain has no physical origins. Instead, he says, it's a distraction created by the brain to help us avoid dealing with unpleasant emotions. According to this theory, your brain does this by instructing the nervous system to decrease the amount of blood flowing to the muscles in your back. This mild oxygen deprivation results in pain, which is so diverting that you can't think about anything else, including those unpleasant feelings.

Chronic pain

The latest theory on chronic pain -- unexplained pain that lasts for more than three months -- is that the body's pain mechanism has simply gone haywire. Think of your brain as a compact disc player and pain as a compact disc. Normally it takes a physical injury to push the "play" button. But in chronic pain patients something goes awry: The "play" button is activated by an unknown source (possibly the memory of a particular pain or psychological factors such as stress), and it's stuck on auto-repeat!

Most back pain goes away within a week or two; fewer than 20 percent of people continue to have pain after six weeks. However, strained ligaments, severe muscle strains, and herniated disks can take up to three months to heal. In a small number of cases, back pain becomes chronic and can continue for several years. Keep in mind, though, that while most pain does not persist day in and day out for months, once you've "thrown your back out," it's likely to happen again.

Back pain is like a cold or a stomachache -- you can usually ride it out with some simple self-help measures. But talk to your physician if you notice any of these symptoms:

•pain so severe that it interferes with your daily activities

•pain that persists for more than a few weeks

•weakness, numbness, pain, or tingling in an arm or leg (which can indicate a nerve being pinched by a herniated disk)

•numbness in the groin or rectal area (you may have a pinched nerve)

•difficulty controlling your bowel or bladder (you may have a pinched nerve)

•high fever (you may have an infection)

Start with simple, self-help measures:

•Rest. Take it easy for a few days to give your body a chance to heal. But avoid complete bed rest, especially for more than two or three days, since inactivity weakens muscles and bones and slows recovery.

•Take over-the-counter pain medications. Anti-inflamatory painkillers, such as aspirin and ibuprofen, reduce inflammation and ease pain.

•Use cold packs. A cold pack or bag of ice wrapped in a towel will numb pain and reduce inflammation, which is particularly helpful during the first 48 hours. After that, try a heating pad or hot showers to relax muscles and increase blood flow.

•Get moving. Taking a short walk or engaging in other gentle exercises will speed your recovery by keeping muscles flexible and strong.

•Get cracking. Many studies have shown that having a chiropractor adjust the joints, ligaments, and muscles in your back can be a fast and effective treatment for back pain.

If your pain persists, consult your doctor, who may advise any of the following:

•Prescription medications. These include anti-inflammatory painkillers and muscle relaxants.

•Physical therapy, which may include special exercises, heat or cold treatments, and massage.

•Antidepressant drugs. These are sometimes used to treat chronic pain; they work by altering the levels of brain chemicals to elevate mood and dampen pain signals.

•Surgery. In a small percentage of cases, having a surgeon remove the part of the disk or bone that is irritating a nerve may provide relief.

•In a word, exercise. Walking , biking , and swimming are all safe, aerobic activities that will build up general fitness. Stretching helps keep your muscles and ligaments flexible, and strengthening exercises for your back and abdominal muscles will help you resist strains and keep your vertebrae comfortably aligned.

•Practice good posture; don't slouch.

•Don't sit or stand still for too long. If you have a desk job or are taking a long car or plane trip, shift your posture from time to time and take stretching breaks.

•Make sure your work surface (whether it's a desk or kitchen counter) is at a comfortable height, so you don't have to bend.

•When sitting, choose chairs with good lower-back support, or put a pillow or rolled-up towel behind the small of your back. Rest your feet flat on the floor; if the chair is too high, get a footrest.

•When standing, prop one foot up on a box or low stool.

•When lifting something, squat down to pick it up -- instead of bending over -- then hold it close to your body and lift with your legs rather than your back.

•When lying down, lie either on your back with a pillow under your knees, or on your side with knees bent and a pillow between them.

•Avoid high-heeled shoes.

References

Last updated January 3, 2006

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